2012-08-15T15:51:19-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-10-01 561698181 STANLY REGIONAL MEDICAL HOSPITAL FOUNDATION STAN 7049823888 POST OFFICE BOX 254 ALBEMARLE NC 28001 JANE BOONE 7049823888 2012-08-15 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z JANE BOONE POST OFFICE BOX 254 ALBEMARLE NC 28001 3161118 0 X WWW.STANLY.ORG X 1990 NC THE ORGANIZATION EXISTS EXCLUSIVELY FOR THE BENEFIT OF STANLY HEALTH SERVICES, INC. 17 17 0 40 0 0 219827 231732 0 0 149264 384533 -38683 -40865 330408 575400 119256 226468 0 0 0 0 0 0 0 38540 23674 157796 250142 172612 325258 5683975 5750822 1979 3009 5681996 5747813 X THE STANLY REGIONAL MEDICAL CENTER FOUNDATION EXISTS EXCLUSIVELY FOR THE BENEFIT OF STANLY HEALTH SERVICES, INC. ITS PRINCIPAL PURPOSE IS TO IDENTIFY, SOLICIT, RECORD, MANAGE AND DISBURSE GIFT INCOME FROM THE PRIVATE SECTOR TO ENSURE THE FUTURE OF EXCEPTIONAL COMMUNITY BASED HEALTH CARE. 0 0 226468 226468 0 IN FISCAL YEAR 2011, IN ADDITION TO GENERAL SOLICITATION OF CHARITABLE CONTRIBUTIONS, THE STANLY REGIONAL MEDICAL CENTER FOUNDATION ADDED SEVERAL MAJOR DONORS (THOSE GIVING IN EXCESS OF $10K OVER TEN YEARS) TO THE ROSTER OF THE STANLY SOCIETY, HAD OVER 175 EMPLOYEES WHO GAVE 1 HOURS PAY PER MONTH BACK TO THE FOUNDATION AS MEMBERS OF THE PRESIDENTS CLUB, AND HELD TWO PUBLIC FUNDRAISERS THAT NETTED OVER $102,344 IN UNRESTRICTED FUNDS WHICH WERE PLACED INTO THE ENDOWMENT. THE FOUNDATION FUNDED OVER A DOZEN HEALTH CARE PROJECTS AND PROGRAMS WITHIN STANLY HEALTH SERVICES AND AWARDED SCHOLARSHIPS TO OVER A DOZEN STUDENTS. 226468 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X JANE BOONE 7049823888 POST OFFICE BOX 254 ALBEMARLE NC 28001 DARRELL ALMOND 1.00 X 0 0 0 RICHARD ALMOND 1.00 X 0 0 0 BOB BEANE 1.00 X 0 0 0 SUE BOHNSACK 1.00 X 0 0 0 ANDY CASTELLOE 1.00 X X 0 0 0 STEVE CUMMING 1.00 X 0 0 0 FRANK GREEN 1.00 X 0 0 0 YOLANDA JOHNSON 1.00 X 0 230336 10278 SUE JORDAN 1.00 X 0 0 0 BILL MULLINIX 1.00 X 0 0 0 DEE PANKEY 1.00 X 0 0 0 LEONARD SALTZMAN 1.00 X X 0 0 0 MIKE SNYDER 1.00 X 0 0 0 SUSAN STOKES 1.00 X 0 0 0 CAROL SULLIVAN 1.00 X 0 0 0 DON SUMMERS 1.00 X 0 0 0 CHRIS VAUGHN 1.00 X X 0 73723 10020 JANE BOONE 28.00 X 0 48627 196 0 352686 20494 0 0 1 0 0 102344 129388 231732 93334 93334 2833352 2542153 291199 291199 291199 0 102344 43565 -43565 -43565 2700 2700 2700 575400 0 0 343668 217468 217468 9000 9000 7379 7379 14516 14516 1779 1779 250142 226468 23674 0 233612 151281 1884 2154 3114 2512 3099 3099 12000 0 5433365 5594875 5683975 5750822 528 3009 1451 0 1979 3009 X 5288380 5344541 183060 192716 210556 210556 5681996 5747813 5683975 5750822 X 325258 -259441 X X 0 1 1 X 0 X 237683 241870 199992 219827 231732 1131104 237683 241870 199992 219827 231732 1131104 159605 971499 169687 182479 134332 149264 93334 729096 -10582 -12003 3678 3317 2700 -12890 1847310 0.52590 0.47400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3099 3099 0 0 INVESTMENTS 5594875 F 5594875 575400 250142 325258 -334441 75000 -259441 65817 349868 -334441 76315 -258126 607994 -32594 -32594 575400 293707 43565 43565 250142 0 250142 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FILING ORGANIZATION IS A NON PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAX ON REVENUE EARNED FROM ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUSES NOR IS IT AWARE OF ANY OF ITS ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2007 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. THE FILING ORGANIZATION HAS ADOPTED THE INCOME TAX STANDARD ISSUED BY FINANCIAL ACCOUNTING STANDARDS BOARD IN LIGHT OF ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFERS FROM AFFILIATES 75,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: TRANSFERS FROM AFFILIATES 75,000. NET ASSETS RELEASED 1,315. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -43,565. RESTRICTED CONTRIBUTIONS 10,971. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 43,565. OUTDOORSMAN'S BONANZA 83484 83484 9294 33200 GALA AUCTION 18860 18860 123 948 102344 102344 9294 33200 123 948 43565 -43565 1 STANLY REGIONAL MEDICAL CENTER INC 301 YADKIN STREET ALBEMARLE NC 28001 560556760 501(C)(3) 201624 SUPPORT COMMUNITY CARE CLINIC 220 YADKIN STREET ALBEMARLE NC 28001 562274174 501(C)(3) 3844 SUPPORT CITY OF ALBEMARLE 144 NORTH 2ND STREET ALBEMARLE NC 28001 N/A 12000 COST LAND ALBEMARLE GREENWAY 3 0 EDUCATIONAL SCHOLARSHIPS 3 9000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: HINSON SCHOLARSHIP: THIS SCHOLARSHIP IS OFFERED TO APPLICANTS WHO HAVE ALREADY COMPLETED TWO YEARS OF UNDERGRADUATE STUDY BY JUNE AND HAVE BEEN ACCEPTED INTO A COURSE OF STUDY IN THE MEDICAL/HEALTHCARE FIELD. APPLICANTS MUST HAVE A 3.5 CUMULATIVE UNDERGRADUATE GPA OR HIGHER. APPLICANTS MUST BE CURRENTLY EMPLOYED BY STANLY HEALTH SERVICES, INC. OR BE THE DEPENDENTS OF A CURRENT EMPLOYEE OF STANLY HEALTH SERVICES, INC. APPLICANTS MUST SUBMIT A STATEMENT EXPLAINING WHAT A CAREER IN HEALTHCARE WILL MEAN TO THEM AND HOW IT WILL BENEFIT HUMANITY. RECOMMENDATIONS FROM A PROFESSOR AND FROM SOMEONE WITHIN STANLY HEALTH SERVICES ARE REQUIRED. FOUNDATION CB CROOK FAMILY HEALTHCARE SCHOLARSHIP: THIS SCHOLARSHIP IS OFFERED TO STUDENTS WHO HAVE ALREADY COMPLETED TWO YEARS OF UNDERGRADUATE STUDY AND HAVE BEEN ACCEPTED INTO A COURSE OF STUDY IN THE HEALTH CARE FIELD. SCHOLARSHIP IS AWARDED BASED ON ACADEMIC PERFORMANCE AND COMMUNITY INVOLVEMENT. APPLICANTS MUST SUBMIT AN APPLICATION, TRANSCRIPT, AND A COMPLETE LIST OF SCHOOL AND COMMUNITY RELATED ACTIVITIES. RECOMMENDATIONS ARE REQUIRED. X X X X X 0 0 0 0 0 0 0 0 0 YOLANDA JOHNSON 0 213836 0 0 0 16500 0 0 0 10278 0 240614 0 0 FORM 990, PART VI, SECTION A, LINE 7B THE STANLY HEALTH SERVICES BOARD OF DIRECTORS MUST APPROVE NEW DIRECTORS NOMINATED TO THE FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 CFO AND CONTROLLER WILL REVIEW AND COPIES WILL BE EMAILED TO BOARD MEMBERS AND REVIEWED AT FINANCE COMMITTEE AND BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF DIRECTORS DECLARES ANY POTENTIAL CONFLICTS OF INTEREST ANNUALLY. MEMBERS WITH POTENTIAL CONFLICTS ARE ASKED TO EXCUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE OF POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE STAFF IS EMPLOYED BY STANLY REGIONAL MEDICAL CENTER. THE FOUNDATION HAS NO EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -334,441. TRANSFERS FROM AFFILIATES 75,000. TOTAL TO FORM 990, PART XI, LINE 5: -259,441. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK OR MORE. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND THE RELATED ENTITIES LISTED ON SCHEDULE R. STANLY MEDICAL SERVICES INC 320 YADKIN STREET ALBEMARLE NC 28001 561892763 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 STANLY REGIONAL MEDICAL CENTER INC 301 YADKIN STREET ALBEMARLE NC 28001 560556760 HOSPITAL NC 501(C)(3) 170(B)(1)(A)(III) N/A 0 STANLY MANOR INC 625 BETHANY ROAD ALBEMARLE NC 28001 561623092 LONG-TERM HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 STANLEX INC 907 NORTH SECOND STREET ALBEMARLE NC 28001 561532751 HEALTHCARE NC 501(C)(3) 509(A)(3) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 STANLY REGIONAL MEDICAL CENTER INC P 75000 EXPENSES STANLY REGIONAL MEDICAL CENTER INC B 201624 CASH STANLY REGIONAL MEDICAL CENTER INC N 50319 SALARY&BENEFITS